Tyrone Muhammad Email & Phone Number

Springfield, Massachusetts, United States

Springfield, Massachusetts Area

The Encounter Reconciliation Supervisor works directly with the Director of the Risk Adjustment team to assist in formulating and executing the strategy and vision of the Encounter Reconciliation Program. The Supervisor function as the team lead and supervise encounter reconciliation analysts. I formulate and execute long term operational/process solutions to increase federal and state acceptance rates within the team’s portfolio. Additionally, I communicates directly with internal and external stakeholders to solve the most complex issues. I am responsible for researching, analyzing, summarizing and categorizing Encounter submission data; also responsible for maintaining an understanding of all outgoing risk adjustment extracts (encounter based, state/federal requirements/vendors); and performing periodic quality control testing to ensure completeness and accuracy of these feeds. I enjoy working with large amounts of data, and am able to find creative solutions to issues, as well as formulate and establish new business processes for the team.

Springfield, Massachusetts Area

While relying on SAS, SQL and Excel, this position consults to better ensure the accuracy of CMS RAPS submissions, EDGE Baseline and quarterly submissions. Also, the best utilization of output report related to EDS, MMR, RAPS-returns, CMS errors, REGTAP presentations/updates, etc... This position combines the functions of a technical business analyst and a certified medical coder. This strategic role merges the clinical knowledge of the medical office/patient encounter with the necessary technical analytics of the resulting data for the overall benefit of the Risk Adjustment department.

Springfield, Massachusetts, United States

Perform on-site or electronic audits of Hierarchical Condition Categories (HCC) medical records/claims to ensure proper medical diagnoses are being submitted for reimbursement.Responsible for the validation of diagnosis codes as well as the identification of missing diagnosis codes submitted on the claim.Provide technical guidance to physicians, nurse practitioners and other staff in identifying and resolving issues such as incomplete or missing documentation, ambiguous or nonspecific documentation or codes that do not conform to approved coding principles/guidelines.Educate and advise staff on proper code selection, documentation, procedures and requirements; identifies training needs, prepares training materials and conducts training for physicians, nurse practitioners and other staff to improve skills on quality documentation and in the collection and coding of health data.

112 Industry Ave, Springfield, Ma 01104

Provide classroom instruction for evening classesMaintain positive student retentionParticipate in Instructor trainingDisplay my experienced in computerized billing and medical keyboardingShare my knowledge of ICD-10, ICD-9, CPT and HCPCSPossess a positive attitude towards change and show a desire to learn new methodologies and systems to benefit a wide range of studentsUtilize my proven interpersonal and persuasive communications skills

Springfield, Massachusetts

• Follow CMS/Medicare proper coding and documentation guidelines for Risk Adjustment Auditing • Advise Physicians and support staff on best practices for proper Medicare patient chart documentation• Review medical records for proper patient diagnosis evaluations and detailed treatment plan.

Springfield, Massachusetts

• Provide detail oriented and payment driven orthopedic surgical coding for various open and arthroscopic procedures performed Baystate Medical Center (Inpatient, Day-stay, Emergency and Outpatient)• Verify and code physician office (NEOS) visits including casting, X-rays and other minor procedures.• Verify coding for Physical Therapist modalities to ensure compliance and proper claim reimbursement.• Perform Physician compliance auditing of modifier 22 usages, correct Evaluation & Management (E&M) levels and proper CCI Edit/coding conflict considerations.• Integrate orthopedic related ICD10-CM codes for billing department from ICD9-CM superbills.• Coding related software includes: SuperCoder, Decision Health’s Orthopedic Decisions, CCI Edits, Sage Intergy and Baystate Medical Center’s Outreach remote access system for surgical operative notes.• Review transcripts and verbal dictates to ensure proper surgical and non-surgical coding.• Provide billing staff daily encounter charge input sheets. • Assist billers with coding adjustments for insurance reimbursement on account receivables.• Provide advance coding scenarios for insurance payment pre-approvals (Workman’s Comp/Auto)• Place treatments, therapies and evaluations in RVU order while applying acceptable modifiers according to CPT and ICD-9CM guidelines and per various payer specifications.• Perform a key role in ICD10-CM conversions of existing ICD9-CM based orthopedic super-bills• Stay familiarized with updated insurance company coding nuances (PQRI, Q-codes, AM, HN, etc..)

Phoenix, Arizona Area

• Consulted students and admissions team on career interests and encouraged academic enrollment. • Rose to the top 7% of Admission Advisors and was inducted in the 2009 Kaplan Talent Circle. • Introduced in May 2009, the standard operating procedure “Sharing Best Practices” which resulted in saving an estimated $15M in potential lost tuition revenue.

Phoenix, Arizona Area

• Generated over 7 years, billion dollar loan portfolios based on various underwriter guidelines. • Managed up to 8 loan officers, performed evaluations and initiated new-hire/follow-up training classes.• Worked with local and nationwide real estate agents to assist potential homebuyers.• Refinanced existing homeowners and offered additional products.

Boston, Ma

• Developed investment comparisons based on duration, benchmark and/or historical performance results.• Calculated, maintained and reported all fund performance.

Bachelor'S Of Science In Data Analytics, Data Modeling/Warehousing And Database Administration, Senior

Certificate Of Completion, Medical Insurance Coding Specialist/Coder

Credits Towards Bsba, Accounting And Finance